Provider Demographics
NPI:1568460764
Name:LEE, CHUNG H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 E ELIZABETH AVE
Mailing Address - Street 2:STE 24
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6505
Mailing Address - Country:US
Mailing Address - Phone:610-865-7871
Mailing Address - Fax:610-867-9675
Practice Address - Street 1:135 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1518
Practice Address - Country:US
Practice Address - Phone:610-826-3141
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD35638L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006421010002Medicaid
PA0006421010002Medicaid
PA076735Medicare ID - Type Unspecified